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HomeMy WebLinkAboutMiscellaneous - 781 WINTER STREET 4/30/2018 (2)Date ... OVI- V1.......... TOWN OF NORTH ANDOVER RMIT FOR WIRING � �; This certifies that...........e.!4.............................................. �r [/ has permission to perform .. ,, ,.��!t2r p✓a LTJ ..... ` .. wiring in the building of.....r�55 j................................................................................................... t ................. r...j ........................................................................... , North Andover, Mass. Fee ...:. !'. t.! Lic. No M. '/ .���. .% ........... ...... ....... ..... ............ .....4........:.a. . .. ...<. .. .......... ...... � � � � � ELECTRICAL INSPECTOR Check # 11971 ,SJ dot 10 -3 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accord--ance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town tis: jNXyA-(\ A t(.X wfj& To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -731 M,y kCr" 4 — Owner or Tenant Owner's Address Is this permit in conjunction vNith a building permit? Yes ❑ No YP (Check Appropriate Box) Purpose of Building (eas I �Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undbrd ❑ N IO. of Meters — Number oi'F'eedenand Arnpacity Location and Nature of Proposed Electrical Work: T7 p ,n\ n r 11 fl—NA v1 n 0 I t✓1 en i >/ v C: M letion of the follom4n table ma • be waived by the, n ector of P: ires. No. of RecessedFixtures ixtures tNo. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lieaing Outlets No. of Hot Tubs Generators KVA No. of Lighting 1� tures Alcove ln- o. or memelncy tg ng g g ls�vimining fool rnd. ❑ rid. ❑ Batter Y units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of .Zones No. of Switches o. o etecuon an No. of Cas Burners Initiatin i;evices a!' Na. of RangesNo. of Air Cond. Tonsl No. of Alerting Devices LV No. of Waste Disposer, Heat Pump Number 'Pons KW No. of Sel€ Conitai Totals: Detection/Alerting Devices No. of Dishwashers (Space/Area Heating KW Local 11MumecP'on ❑ Other No. of Dryers Heating Appliances KW Security S} stems: No. of I;evices or Equivalent No. of VVater`,l, N o. of o. of Data Wiring: . Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications Wicing: OTHER -No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of fires. INSURANCE COVE AGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The r undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CI CK ONE: 1NSURAltiCE y T301�TD ❑ OTHER ❑ (Specify:) l Ll "V 1 1 �+� ��• AaerLl Estimated Value of Electrical Work �"irA °�"a� //,,�. � (Vl>hen required by municipal policy) to Start. C ' W4(ft ttd in accordance with MEC Rale 10, and upon completion. I certify, under the pains andpenalties of perjury, that the Lnfor ttafion On this application is true and complete. FIRM NAME: Nrb Qi 'L LIC. NO. - A_ Licensee: Signature l i IC. NO.: (If applicable, enter "exempt" in the li erase number line) OWNER'S INl required by law Owner/Agent Signature La t!vw, B . Tel. Alt. Tel. No.: 5 Il2ANCE WAi EEc: I am aware that the ,Licensee do not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. L ir, l fTT „EE • S ►a Zai I�j R�� �i� r��� Commonwea;th of Massachusetts Department ofFireServices BOARD OF FIRE PREVENTION REGULATIONS anc Rev. 1/9�y L ] Official use Only and Fes Checked (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accord--ance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: City or Town tis: jNXyA-(\ A t(.X wfj& To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -731 M,y kCr" 4 — Owner or Tenant Owner's Address Is this permit in conjunction vNith a building permit? Yes ❑ No YP (Check Appropriate Box) Purpose of Building (eas I �Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undbrd ❑ N IO. of Meters — Number oi'F'eedenand Arnpacity Location and Nature of Proposed Electrical Work: T7 p ,n\ n r 11 fl—NA v1 n 0 I t✓1 en i >/ v C: M letion of the follom4n table ma • be waived by the, n ector of P: ires. No. of RecessedFixtures ixtures tNo. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lieaing Outlets No. of Hot Tubs Generators KVA No. of Lighting 1� tures Alcove ln- o. or memelncy tg ng g g ls�vimining fool rnd. ❑ rid. ❑ Batter Y units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of .Zones No. of Switches o. o etecuon an No. of Cas Burners Initiatin i;evices a!' Na. of RangesNo. of Air Cond. Tonsl No. of Alerting Devices LV No. of Waste Disposer, Heat Pump Number 'Pons KW No. of Sel€ Conitai Totals: Detection/Alerting Devices No. of Dishwashers (Space/Area Heating KW Local 11MumecP'on ❑ Other No. of Dryers Heating Appliances KW Security S} stems: No. of I;evices or Equivalent No. of VVater`,l, N o. of o. of Data Wiring: . Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP elecommunications Wicing: OTHER -No. of Devices or Equivalent Attach additional detail if desired, or as required by the Inspector of fires. INSURANCE COVE AGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The r undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CI CK ONE: 1NSURAltiCE y T301�TD ❑ OTHER ❑ (Specify:) l Ll "V 1 1 �+� ��• AaerLl Estimated Value of Electrical Work �"irA °�"a� //,,�. � (Vl>hen required by municipal policy) to Start. C ' W4(ft ttd in accordance with MEC Rale 10, and upon completion. I certify, under the pains andpenalties of perjury, that the Lnfor ttafion On this application is true and complete. FIRM NAME: Nrb Qi 'L LIC. NO. - A_ Licensee: Signature l i IC. NO.: (If applicable, enter "exempt" in the li erase number line) OWNER'S INl required by law Owner/Agent Signature La t!vw, B . Tel. Alt. Tel. No.: 5 Il2ANCE WAi EEc: I am aware that the ,Licensee do not have the liability insurance coverage normally By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Telephone No. L ir, l fTT „EE • S ►a Zai I�j R�� �i� r��� The Commonwealth of Massachusetts De,"g-rtment of InduvrialAccidents r` Office of Investigations 1 Congress Street, Suite 100 �'�� Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: BuildersiContractors/Electricians/'lumbers Name (Business/Urganizauionilndividual): Northern Lights Ei@ctrlc, Inc. Address: 50 i=isher Street City/State/Zi-p: North Attleboro, MA 02760 Phone #: (503) 699-9251 Are you an employer? Check the aprrorriate box-, 1. I am a e-mpioyer with 10 4. I ar n a general contractor and I employees (full and/or part -t me).* have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attackied sheet, ship and have no employees Thcsc sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.'- nsurance.+required.] required.] 5. We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' comp, insurance required.] Type of project (required): V. C] New construction 7. Remodeling S. Derlolition 9. Building addition 10.0 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.1.7 Roof repairs 13.-1 other *Any applicant that checks box ##1 must also fill out the section below showing their workers' compensation policy information. l .1 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or rot those entities have employees. If the suit -contractors haW erriglayces, they must proVide thcir workers, eo tag. policy number. X am an eanplhyar that is providing workers' compensation insurance for MY employees. Below is the policy and job site information. ins4rance Company 'amc; PaychP.x Insurance Agency Policy # or self iris. Lic. : NOWG422539 Expiration Date: 02/04/2014 Job Site Address: City/StatelZip:�� ,Attach a copy of the workers' compeAsation policy declaration( a e shun Failure to secure coverage as required under Section 25A of MGL c.. 152 can lead to the impo�tio xher o: criminal pe alti and expirationd of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a 1Z TOP �xt'oP { ORDER and a fine of up to $250.00 a day against the violator, Be advised that a copy cif this statement may be forwarded to the 0--ce of Investigations of the DIA for insurance coverage verification, I do hereby ceIVfy under the pains and penalties of perjury that the information provided alcove is trice and correct 508-699-9251 Official use only. Do not nrite in this area, to be completed by city or town vf�icial. Cityor Town: Permit/License # Issuing Author* (-circle one): I. Board of :Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Insp`etor 6. Other Contact Person Ph one #: Date.. ...?...`..�1.......... �o� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....-"...:'�� --� ............................................................ has permission to perform� ........ wiring in the building of r........................................................................... at ��f /....... �.'.... r'`......'�.............................. . North Andover, Mass. r Fee`'"�.�....... Lic. No:3 gi'—V( `G ... L` ........... ELECTRICAL INSPECTOR �- Check # 7279 0 Ll - 2 --0-7 P4� s �C\ Commonwealth of Massachusetts o Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 42 %p ^UZ� Occupancy and Fee Checked :ev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: .3� Wo,7 City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) h �;T/ W/�� -Zsl Owner or Tenant �t Owner's Address C»Y rl- Is this permit in conjunction with a building permit? Yes STelephone No. No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 14Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: .e 6 Completion of the following, table may he waived by the In.cnvctnr n(Wire.c No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans No. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- 1:1 rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pum Totals Number .... Tons K No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of EI ctrical Work: � (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE C VE AGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cove age is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains a4d penalties of perjury, that the information on this application is true and complete. FIRM NAME:../ �� j"/C G GC e LIC. NO.:v Licensee: �110W_ �`�'� Signature _ LIC. NO.: / a hcable!e ter ' ena t i the lic e ama!!� ane. _ if r / j� _ //W Bus. Tel. No.: G Address: E G?! ��-Alt. TeL No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. 1 am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $�� Date. .o TOWN OF NORTH OVER FOR PERMIT PrMBING This certifies that ....A.,. -T'. -/" - - - P,/, I I ............. has permission to perform .... ................. plumbing in the buildings of ... 0. el.4 7 ................... at .... / ..t'f. 10., 5-'e.:........ North Andover, Mass. Fee. . Lic. No... /) 63 . 1 . ..... 11 -- - PLUMBING INSPECTOR Check , # 36 ? 7327 M Y? IPIYTI IQrC MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: North Andover , MA. Date: 03/23/2007 Permit#��- Building Location: 781 winter Street Owners Name: 781 wintV Street Type of Occupancy: Commercial Educational Industrial Institutional Residential ✓ New: ✓ Alteration: Renovation: Replacement: Plans Submitted: Yes No IPIYTI IQrC INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ✓ 'No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy V Other type of indemnity Bond OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner -- Agent - - I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my .�...,.. !J0 d„u ulda dit piummng worK ano mstanations perrormed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - --- BY Type of License: ,171 Title Plumber Signatdreof Li9bnsed Pfur,ber Master City/Town Journeyman License Number: 15032 APPROVED OFFICE USE Y ONL- Z Z W Z U "� J 2 IN— W N Z a z IQ— IY R g Z F. W !n Z Q H of Q y O 0 W a F ag w 0 a z �a z ai v a JO u- f- �'W p F- N J J = W IY U Q 1-- x Q N IL N p N Q 3 O V>; O O= G a. O Z z w N Q Q H= Q Q J Q Q it W J U) Q H 3 I- O SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR —fu --FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR Check One Only Certificate #bing Installing Company Name: RTP Plum and Heating - - — Corporation Address:, PO Box 203 _ City/Town North Andover State:. MA = _ Partnership Business Tel: _978-361-5399 Fax: 978-688-9256 - �/ Firm/Company Name of Licensed Plumber: Roger Monty INSURANCE COVERAGE: 1 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes ✓ 'No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy V Other type of indemnity Bond OWNER'S INSURANCE WAIVER: 1 am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner -- Agent - - I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my .�...,.. !J0 d„u ulda dit piummng worK ano mstanations perrormed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. - --- BY Type of License: ,171 Title Plumber Signatdreof Li9bnsed Pfur,ber Master City/Town Journeyman License Number: 15032 APPROVED OFFICE USE Y ONL- Location / �1 No. /7/Date y NORTN TOWN OF NORTH ANDOVER • �ffi?C'� ; , Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s�CHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL Check # 6740 --Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING ""z '3`` -*.-z' s zk-;,,�P..�bas_"y✓ ,., ""' �, rD". �� t:n 3 z+Y 777 BUILDING PERMIT NUMBER: 19� DATE ISSUED:-1� ✓�� SIGNATURE: jvlAf&�� Building Commissioner/I r of Buildings Date SECTION 1- SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: Zoning District Proposed Use 1.4 Property Dimensions: Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 0 3D 3a 3 0 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: Public ❑ Private Zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal ❑ On Site Disposal System ❑ SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record W/0 LV,- sill Name (Pn ) Address for Service: Signaturd v Telephone 2.2 Owner of Record: Name Print Address for Service: Q_-3 � �\ u V �1 Signature le hone SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor:: Licensed Construction Supervisor: Address Signature Telephone Not Applicable ❑ License Number Expiration Date 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date Signature Telephone T M X ic z O A� V SECTION 4 - WORKERS COMPENSATION (M -G-1. C 152 s '74,1m Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes .......❑ No ....... 0 SECTION 5 Descri tion of Proposed Work check au applicable) New Construction Existing Building 0' Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work:: 00 SECTION 6 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollar) to be Completed b_permit a licant OFFhCxAL USEi)NLY 1. Building(a) Ul%� (a) Building Permit Fee Multiplier 2 Electrical 11yG� J <C /% (b) Estimated Total Cost of Construction CK 3 Plumbing Building Permit fee tel X (b) C 0 4 Mechanical HVAC /4. 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L1, as Owner/Authorized Agent of subject property Hereby auth ' e to act on My behalf, in all tters relative o 7work uthorized by this building permit application. ` ��- '9603 Signature of Owner Date SECTION 7b 13"""' -'---ORIZED AGENT DECLARATION 1, L-414 -111-dL41,,as Owner/Authorized Agent of subject property Hereby declare that the statements and information on thforegoing application are true and accurate, to the best of my knowledge and belief Lh�-t a [n i (qcaa�-- 4,4 Print Nam Signature of O r/A ent . Date J NO. OF STORIES SIZE ' S ` BASEMENT OR SLAB $�¢CCA/4 "7�l e S SIZE OF FLOOR TAMERS 1 X l d 2 3 SPAN DA ENSIONS OF SILLS DEvIENSIONS OF POSTS ° DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION G/ 7a -OE S THICKNESS Q" SIZE OF FOOTING X MATERIAL OF CH EY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE FORM U - LOT RELEASE FORM f�400AOA) INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. PPLICANT FILLS OUT THIS SECTION APPLICANT Y �. �Cr �-- ii PHONE/�/ ✓J �� b b LOCATION: Assessor's Map Number I � PARCEL—1 a SUBDIVISION ( r LOT (S) STREET V In pry , ST. NUMBER ** *******.******`OFFICIAL USE RE I CONMENDATIONS TOWN AGENTS: d POWSMRVA�TJON ADM INI ATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER COMMENTS DATE APPROVED DATE REJECTED WOOD INSPECTOR -HEALTH DATE APPROVED ` DATE REJECTED 6EPTIC INSPECTOR -HEALTH DATE APPROVED. "Z Z DATE -REJECTED V COMMENTS Ned C� r (2 n6 Z w ^ L PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTO Revised 9W jm DATE Town of North Andover Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. FOR ROOFING, SIDING, INTERIOR REHABILITATION PERMITS 1) BUILDING PERMIT APPLICATION 2) DEBRI REMOVAL FORM 3) WORKERS COMP AFFIDAVIT 4) PHOTO COPY OF H.I.C. AND/OR C.S.L. LICENSES 5) COPY OF CONTRACT 6) FLOOR PLAN OF PROPOSED INTERIOR WORK FOR ADDITIONS / DECKS 1) BUILDING PERMIT APPLICATION 2) FORM U 3) MORTGAGE PLOT PLAN (MINIMUM)' 4) DEBRI REMOVAL FORM 5) WORKERS COMP AFFIDAVIT 6) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 7) COPY OF CONTRACT 8) FLOOR/CROSSSECTION/ELEVATION PLAN OF PROPOSED WORK WITH SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT (if applicable) FOR NEW CONSTRUCTION (SINGLE AND TWO FAMILY) 1) BUILDING PERMIT APPLICATION 2) FORM U 3) GROWTH MANAGEMENT BYLAW 4) CERTIFIED PROPOSED PLOT PLAN 5) PHOTO COPY OF H.I.C. AND C.S.L. LICENSES 6) WORKERS COMP AFFIDAVIT 7) TWO SETS OF BUILDING PLANS (one to be returned) TO INCLUDE SPRINKLER PLAN AND HYDRAULIC CALCULATIONS (if applicable) 8) COPY OF CONTRACT (if applicable) 9) MASCHECK ENERGY COMPLIANCE REPORT In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the board of appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with application. Tel: 978-688-9545 Town of North Andover Building Department 27 Charles Street North Andover MA 01845 HOMEOWNER LICENSE EXEMPTION Please print. r DATE 5 JOB LOCATIO umber Street Address v Section of Tow "HOMEOWNER 11 D 1 "1 /� �� 6 6— 3 �i S Number Home Phone Work Phone PRESENT MAILING ADDRESS i W Ij r City Town State Zip Code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Section 109.1. 1) DEFINITION OF HOMEWOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner' shall submit to the Building Official, a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other Applicable codes, by-laws, rules and regulations, The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedytjes and requirements and that he/she will comply with said procedures and requiremetnts. l/ , HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIA Note: Three family dwelling 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0 Construction Control. M O td '.Mwmmo uj z co 'as c .c� C y O C ci CL M t c 4 o Q Q�ev �y=� E o O C. �. m=CON E �im- O1' - y y� Z `( � ' y L:_mzip 'd= '=oO y O V! 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C) stn' d a n L �tDO�n O �1n "10Cb 3'0177=W D D �: Cb n. n• m «� e+ O m cm, f Im m ew. ne v Z C) t+ o tn aJ» e`ta o7 6-c rx�fc 0 m o r sli c n�Unm G o s m c,..,.= D a -l3 %C cr C: Z m 12- m N O rn w c�• .••v .�=m N 17 CL Z tcn 0 m� G Wm Cb (A -7 N_ cr CL N m C) �i 7 o `1 -h t'Q a H N Q o mn fl �� V -3 Khoter Residence IbI Winter street North Andover, MA 0045 JOANNA RECK A R G H I T E G T G -I Ghestnut St., Andover, MA 01510 ph: 918.410.3068 fx: 918.410.3133 First door Plan New SCALE: 1/4"= 1'-0" (m V' m z u 02003 ----- --� Illi I r ---------- I L — I 70 i m 1 70 m , F- < I 0 �D Z - �d m I r r (P 2 m U) d m m m F— m J> O z Khater Residence 151 Winter street � O North Andover, MA 01545 LJ i'-6" L� I LL I ON 3= Ay �r 1 =� rnN xz Np zm I JOANNA RECK Rear Elevation A R G H I TE G T ■ New ql Ghestnut St., Andover, MA 000 5GALE; 1/4" =1'-a' • ► I o� o� 00 oI JOANNA RECK o Khater Residence Existin q ®� o ARCH I TELT 181 Winter Street Basement Floor Pion ( North Andover, MA 01845 q-7 Chestnut St., Andover, MA 0010 SCALE: 3116° = 1'-0" ph: 918.410.30b8 fx: 918.410.3133 ©2003 o� O 0 Z a lip o� z Oo o© DN N4 � Iz 2 DN (1 II 1 1 11 1 1 II 11 II II II � II � 1 r 1 rn I II II II II II II II II Khater Residence JOANNA Existin /Demolition ARGHI TEE G LT T 8 51 Winter street First Floor Plan North Andover, MA 01845 Q7 Gheatnut St., Andover, MA 01810 SCALE: 3/16" = r -o" ph: glb.4103068 fx: 918.410.3133 ©2005 rn rn � d O 00 O � 3 O O D x a z 0 V rn3 d D O� O rn — — — — — — — — — — — — — — — — — — — — --1 I I � I L-------------------------- i � 0 Khater Residence JOANNA RECK Existing , A R G H I T E G T 0 I81 Winter Street Second Floor Pion North Andover, MA 01845 q7 Ghe5tnut St., Andover, MA 0010 5GALE: 5/16° = 1'-0" ph: 918.410.3068 fx: -118.410.3133 @2003 Date .... I.!.`.�.... .... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .....tC. t v Sriw t f ................................N.................................... has permission to perform wiring in the building of ...... r.11..f}..C................................................. a at ...... 9.�...... ..�.'U.......................................... . North Andover, Mass. u Fee ....:3:5......... Lic. No. A..3� 2 ....................................... -e Co ( �...................... . ELECTRICAL INSPECTOR Check # 0118 06-16. L;. TBECOMMONWEALYHOFMASSACHUSEHS Office Use only ` DEPARTA1ENW0FPUB11CS9= permit No. BOAROOFFREPREVEMONREGULA77ONS527CMR120 . Occupancy & Fees Checked APPLICATIONFOR PEJTO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE W THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATIbN) Date I Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) '781 W I�J TER ST Owner or Tenant Owner's Address <A -M L To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes [ No r7 (Check Appropriate Box) Purpose of Building AWL'-Ui Al Utility Authorization No. Existing Service 122 0 0 Amps P70/e)Volts Overhead Underground No. of Meters New Service Amps Volts Overhead Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work AI 1T1 DAl f Rj446 - Ll --5, No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA ground 1:1J round No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other No. of Dryers Heating Devices KW ED Connections No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER• h>SSaMWCC)VW - Puts<ianttothetegttitmnattsofM sGffffALaws - �.,,/ Ibareaaneml�abl7dyhlauartu =Rhein kxig(AxT!ete ' Co�aageoritsabunf legttivalft YES ' T NO 8 IbavestlbmrttadvaidptoofofsamelDtbeOffim YES rip F)mhawdrdodYFS,pkaseir thetypeofcovt Wby gtebo 1�_—J INSURANCE IBOND OTHER r-1 (PleaseSpedy) 1 L( O 2 Date W t LL e -A -t L. Esha ValueofFJectdcd[Wak $ WotktoStart /17 bVectimDateRoWested Rough Final SignadunderTiePof FIRMNAME O fa 1! 5 L L ec_-r I Lk=No. 7Z *2-- Lim Signapue LimwNo �-� l U 1 Busi mTel.No. �7S S'3-- 6 b 9 o r AcirlrP�e t&I Q -:R OVP? ST -Lvl "4 a-9 ODy 01g61y AItTeL To.�7�—�66—,S;62'y -OWNER'SINSURANCEWAIVFR;Iamawateda &Liomsedoesnothavethei covaageoritssubstamalegiiivalentasopredbyN %adneettsGmn dLaws y and thatmysignahneonthispe=apphcatimwaivesthi mWi miem (Please check one) Owner Agent 4 Telephone No. PERMIT FEE $ Signature o caner or gen The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Address City' Phone #: Insurance. Co. Policv # Company name: Address City. Phone # Insurance Co. _ Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment.as weU_as.ciALpenaltiesinshe%m da -STOP MRK_ORDF I and_afore_of.(,$1jDD D)_atJayagainst.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. ti / do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Pbone.# Official use only do not write in this area to be completed by city or town official' Y City or Town Permit/Licensing. Building Dept E]Check if immediate response is required Licensing Boars! p Selectman's Office Contact person: Phone #: E] Health Department Other